@layout("/common/_form.html",{js:["/assets/common/libs/pinyin/initials.js","/assets/common/libs/pinyin/pinyin.js","/assets/modular/system/btyBxda/btyBxda_adddgd.js","/assets/modular/system/dgdzxChengbenMingxi/zxChengbenMingxi_new.js"]}){
<style>
    .btnshop {
        display: inline-block;
        height: 38px;
        line-height: 38px;
        padding: 0 18px;
        background-color: #009688;
        color: #fff;
        white-space: nowrap;
        text-align: center;
        font-size: 14px;
        border: none;
        border-radius: 2px;
        cursor: pointer;
        margin-bottom: 10px;
    }
    a:hover {
        color: #FFFFFF;
    }
</style>

<form class="layui-form" id="noticeForm" lay-filter="noticeForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="roleId" type="hidden"/>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">店名</label>
                        <div class="layui-input-block">
                            <select name="dm" lay-filter="language" id="dm" lay-search="">
                                <option value='东更道'>东更道</option>
                            </select>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label">姓名<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="xm" placeholder="请输入姓名" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label">供货商<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="ghs" placeholder="请输入供货商" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label">银行卡号<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="yhk" id="yhk" placeholder="请输入银行卡号" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>

                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label">行号</label>
                        <div class="layui-input-block">
                            <input name="bz" id="bz" placeholder="请输入行号" type="text" class="layui-input"/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label">会计<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="kj" placeholder="请输入会计" value="${username}" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <a class="btnshop" id="btnExp">识别行号</a>
        <button class="layui-btn" lay-filter="btnnnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" ew-event="closeDialog">&emsp;取消&emsp;</button>
    </div>
</form>

@}
